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Dabic-Stankovic K, Rajkovic K, Stankovic J, Marosevic G, Kolarevic G, Pavicar B. High-dose-rate Brachytherapy Monotherapy in Patients With Localised Prostate Cancer: Dose Modelling and Optimisation Using Computer Algorithms. Clin Oncol (R Coll Radiol) 2024; 36:378-389. [PMID: 38584072 DOI: 10.1016/j.clon.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
AIMS Interstitial high-dose-rate brachytherapy (HDR-BT) is an effective therapy modality for patients with localized prostate carcinoma. The objectives of the study were to optimise the therapy regime variables using two models: response surface methodology (RSM) and artificial neural network (ANN). MATERIALS AND METHODS Thirty-one studies with 5651 patients were included (2078 patients presented as low-risk, 3077 patients with intermediate-risk, and 496 patients with high-risk). A comparison of these therapy schedules was carried out using an effective biologically effective dose (BEDef) that was calculated assuming the number of treatment days and dose (D) per day. The modelling and optimization of therapy parameters (BEDef and risk level) in order to obtain the maximum biochemical free survival (BFS) were carried out by the RSM and ANN models. RESULTS An optimal treatment schedule (BFS = 97%) for patients presented with low-risk biochemical recurrence would be D = 26 Gy applied in one application, 2 fractions at least 6 h apart, within an overall treatment time of 1 day (BEDef = 251 Gy) by the RSM and ANN model. For patients presented with intermediate- or high-risk an optimal treatment regime (BFS = 94% and 90%, respectively) would be D = 38 Gy applied in one application, 4 fractions at least 6 h apart, with an overall treatment time of 2 days (BEDef = 279 Gy) by the RSM and ANN models. CONCLUSIONS The RSM and ANN models determine almost the same optimal values for the set of predicted therapy parameters that make a feasible selection of an optimal treatment regime.
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Affiliation(s)
- K Dabic-Stankovic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - K Rajkovic
- Academy of Applied Preschool Teaching and Health Studies, Krusevac, Serbia; Bijeljina University, Republic of Srpska, Bosnia and Herzegovina.
| | - J Stankovic
- Bijeljina University, Republic of Srpska, Bosnia and Herzegovina; Academy for Applied Studies Belgrade, The College of Health Sciences, Zemun, Serbia.
| | - G Marosevic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - G Kolarevic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - B Pavicar
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
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Tiruye T, O'Callaghan M, Ettridge K, Moretti K, Jay A, Higgs B, Santoro K, Kichenadasse G, Beckmann K. Clinical and functional outcomes for risk-appropriate treatments for prostate cancer. BJUI COMPASS 2024; 5:109-120. [PMID: 38179028 PMCID: PMC10764171 DOI: 10.1002/bco2.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives To describe real-world clinical and functional outcomes in an Australian cohort of men with localised prostate cancer according to treatment type and risk category. Subjects and methods Men diagnosed from 2008 to 2018 who were enrolled in South Australian Prostate Cancer Clinical Outcomes Collaborative registry-a multi-institutional prospective clinical registry-were studied. The main outcome measures were overall survival, cancer-specific survival, decline in functional outcomes, biochemical recurrence and transition to active treatment following active surveillance. Multivariable adjusted models were applied to estimate outcomes. Results Of the 8513 eligible men, majority of men (46%) underwent radical prostatectomy (RP) followed by external beam radiation therapy with or without androgen deprivation therapy (EBRT +/- ADT) in 22% of the cohort. Five-year overall survival was above 91%, and 5-year prostate cancer-specific survival was above 97% in the low- and intermediate-risk categories across all treatments. Five-year prostate cancer-specific survival in the active surveillance group was 100%. About 37% of men with high-risk disease treated with RP and 17% of men treated with EBRT +/- ADT experienced biochemical recurrence within 5 years of treatment. Of men on active surveillance, 15% of those with low risk and 20% with intermediate risk converted to active treatment within 2 years. The decline in urinary continence and sexual function 12 months after treatment was greatest among men who underwent RP while the decline in bowel function was greatest for men who received EBRT +/- ADT. Conclusion This contemporary real-world evidence on risk-appropriate treatment outcomes helps inform treatment decision-making for clinicians and patients.
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Affiliation(s)
- Tenaw Tiruye
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
- Public Health DepartmentDebre Markos UniversityDebre MarkosEthiopia
| | - Michael O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes CollaborativeAdelaideAustralia
- Flinders Health and Medical Research InstituteFlinders UniversityAdelaideAustralia
- Discipline of MedicineUniversity of AdelaideAdelaideAustralia
- Flinders Medical CentreBedford ParkAustralia
| | - Kerry Ettridge
- Health Policy CentreSouth Australian Health and Medical Research InstituteAdelaideAustralia
- School of Public HealthUniversity of AdelaideAdelaideAustralia
| | - Kim Moretti
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
- South Australian Prostate Cancer Clinical Outcomes CollaborativeAdelaideAustralia
- Discipline of SurgeryUniversity of AdelaideAdelaideAustralia
| | - Alex Jay
- Flinders Medical CentreBedford ParkAustralia
| | - Braden Higgs
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideAustralia
| | - Kerry Santoro
- Southern Adelaide Local Health NetworkAdelaideAustralia
| | - Ganessan Kichenadasse
- Flinders Health and Medical Research InstituteFlinders UniversityAdelaideAustralia
- Flinders Medical CentreBedford ParkAustralia
| | - Kerri Beckmann
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
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Deivasigamani S, Orabi H, El-Shafei A, Adams ES, Kotamarti S, Aminsharifi A, Davis L, Wu Y, J SJ, Polascik TJ. Intermediate-term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score-matched analysis. Prostate 2023; 83:1373-1386. [PMID: 37469120 DOI: 10.1002/pros.24600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). We studied the intermediate oncological and functional outcomes of patients who underwent SCT following cryotherapy (CRYO-SCT) recurrence and compare it to recurrence after brachytherapy (BT-SCT). METHODS An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- and 5-years post-SCT. Secondary endpoints assessed functional outcomes including urinary continence, erectile function, and recto-urethral fistula. Association between treatment and biochemical progression-free survival was assessed using inverse probability weighted (IPTW) Cox proportional hazards regression. The differences in the secondary functional outcomes were assessed by Pearson's χ2 test or Fisher's exact test, corrected for IPTW. RESULTS A total of 194 patients met inclusion criteria. The BCR rate for BT-SCT and CRYO-SCT was 23 (20.4%) and 17 (21%) at 2 years and 30 (26.5%) and 22 (27.2%) at 5 years according to Phoenix criteria. There was no statistical difference in 2 years (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.5-1.7, p = 0.7) or 5-year BCR (HR: 0.86; 95% CI, 0.5-1.5, p = 0.6) between the groups. The functional outcomes like urinary continence (p = 0.4), erectile function (p = 0.1), and recto-urethral fistula (p = 0.3) were not statistically different. CONCLUSION CRYO-SCT appears to be well tolerated, with comparable oncological and functional outcomes to patients failing primary BT. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial CRYO with minimal morbidity. SCT is a viable treatment option to salvage local PCa recurrence following either BT or cryoablation failure.
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Affiliation(s)
- Sriram Deivasigamani
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Hazem Orabi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Urology Department, Assiut University, Assiut, Egypt
| | - Ahmed El-Shafei
- Department of Urology, University of Florida Health, Jacksonville, Florida, USA
| | - Eric S Adams
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Srinath Kotamarti
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Ali Aminsharifi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Leah Davis
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Yuan Wu
- Duke Cancer Institute and Department of Statistics, Durham, North Carolina, USA
| | | | - Thomas J Polascik
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
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Kadeerhan G, Xue B, Wu X, Hu X, Tian J, Wang D. Novel gene signature for predicting biochemical recurrence-free survival of prostate cancer and PRAME modulates prostate cancer progression. Am J Cancer Res 2023; 13:2861-2877. [PMID: 37559989 PMCID: PMC10408486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/02/2023] [Indexed: 08/11/2023] Open
Abstract
Biochemical recurrence (BCR) is considered as an early sign of prostate cancer (PCa) progression after initial treatment, such as radical prostatectomy and radiotherapy; hence, it is important to stratify patients at risk of BCR. In this study, we established a robust 8-gene signature (APOF, Clorf64, RPE65, SEMG1, ARHGDIG, COMP, MKI67 and PRAME) based on the PCa transcriptome profiles in the Cancer Genome Atlas (TCGA) for predicting BCR-free survival of PCa, which was further validated in the MSK-IMPACT Clinical Sequencing Cohort (MSKCC) PCa cohort. Moreover, we found that one risk-related gene (PRAME) was upregulated in tumor samples, particularly in high-risk group was well as in patients metastatic tumor and was correlated with chemotherapeutic drug response. In vitro experiments showed that knocking down PRAME reduced the proliferation, migration, and invasion of PCa cells. Therefore, our study established a new 8-gene signature that could accurately predict the BCR risk of PCa. Inhibition of PRAME attenuated the proliferation, invasion, and migration of PCa cells. These findings provide a novel tool for stratifying high-risk PCa patient and shed light on the mechanism of PCa progression.
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Affiliation(s)
- Gaohaer Kadeerhan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen 518116, China
| | - Bo Xue
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen 518116, China
- Shanxi Medical UniversityShanxi 030012, China
| | - Xiaolin Wu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen 518116, China
| | - Xiaofeng Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen 518116, China
- Shanxi Medical UniversityShanxi 030012, China
| | - Jun Tian
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen 518116, China
| | - Dongwen Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen 518116, China
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Wala J, Nguyen P, Pomerantz M. Early Treatment Intensification in Metastatic Hormone-Sensitive Prostate Cancer. J Clin Oncol 2023; 41:3584-3590. [PMID: 37267579 PMCID: PMC10325768 DOI: 10.1200/jco.23.00723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 06/04/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in the Journal of Clinical Oncology, to patients seen in their own clinical practice.For generations, oncologists and urologists have used androgen deprivation therapy (ADT) to manage metastatic hormone-sensitive prostate cancer (mHSPC). Until recently, ADT monotherapy was standard. Within the past decade, a series of trials have clearly demonstrated improved outcomes with a more aggressive up-front approach. Doublet intensification therapy, involving either ADT plus docetaxel or ADT plus any of several second-generation oral androgen-receptor pathway inhibitors (ARPIs), provide considerable survival advantages compared with ADT alone. In 2022, two trials, PEACE-1 and ARASENS, demonstrated the potential of triplet therapy, adding an ARPI to an ADT-docetaxel doublet. In the Original Report that accompanies this article, the authors provide a post hoc analysis of ARASENS (ADT plus docetaxel, with or without darolutamide), identifying the subpopulations of patients with mHSPC who might benefit most from a triplet regimen. They segment the ARASENS cohort by disease volume and disease risk profile, finding that triplet therapy is associated with improved outcomes regardless of category (although with limited power in the low-volume cohort). Meanwhile, trials are ongoing examining the role of radiotherapy (RT) in mHSPC, a modality previously reserved for localized disease or isolated, symptomatic metastases. Here, we present a mHSPC case and discuss our approach to mHSPC considering recent studies. We recommend triplet therapy for patients who are suitable candidates for chemotherapy, especially for patients with high-volume disease. We also favor aggressive use of RT, when feasible, for patients with low-volume mHSPC.
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68Ga-PSMA PET/CT in early relapsed prostate cancer patients after radical therapy. Sci Rep 2022; 12:20500. [PMID: 36443430 PMCID: PMC9705359 DOI: 10.1038/s41598-022-24688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Biochemical recurrence (BCR) of prostate cancer (PCa) occurs in about 25% of patients treated with radical prostatectomy (RP) and up to 45% in patients who receive external beam radiotherapy (RT). Early diagnosis of PCa recurrence is of high importance for successful salvage therapy. The aim of the present study is to analyze the efficacy of 68 Ga-PSMA PET/CT in detecting the presence of local and/or systemic disease in patients with a history of PCa who have BCR. A total of 52 PCa patients with BCR referred for 68 Ga-PSMA PET/CT were recruited from the American University of Beirut Medical Center between November 2017 and December 2019. We compared the performance of PSMA PET/CT to the results and clinical factors based on follow up: PSA, PSA kinetics, primary treatment, and Gleason score. The relationship between the PET/CT findings and clinical indicators of disease were assessed by univariate and multivariate logistic regression. From a total of 52 patients, 34 (65.4%) had positive PSMA-PET/CT scans. Among those, 8/34 (23.5%) received primary RT. For all patients with a positive PSMA-PET: the detection rate was 2/4 (50%) for PSA < 0.2, 5/10 (50%) for PSA 0.2-0.49, 3/6 (50%) for PSA 0.5-0.99, 6/12 (50%) for PSA 1-1.99, 8/9 (88.9%) for PSA 2-3.99, and 10/11 (90.9%) for PSA 4-10.PSMA-PET/CT positivity was significantly associated with PSA level at time of PET scan, PSA doubling time, Gleason score and TNM staging. However, it did not show a significant correlation with radiotherapy as primary treatment, ongoing androgen deprivation therapy (ADT), time to relapse, and initial PSA before therapy. In our single center prospective trial, 68 Ga-PSMA PET/CT successfully detected the recurrence of PCa in patients with BCR. Scan positivity was significantly associated with PSA level at time of PET scan, PSA doubling time, Gleason score, and TNM staging. PSMA- PET/CT is a highly promising modality in the work up of patients with PCa in the setting of BCR for earlier detection of disease recurrence.
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Wang F, Luan Y, Fan Y, Huang T, Zhu L, Lu S, Tao H, Sheng T, Chen D, Ding X. Comparison of the Oncological and Functional Outcomes of Brachytherapy and Radical Prostatectomy for Localized Prostate Cancer. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101387. [PMID: 36295548 PMCID: PMC9609680 DOI: 10.3390/medicina58101387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022]
Abstract
Background and Objectives: To compare the oncological and functional outcomes of brachytherapy (BT) and radical prostatectomy (RP) in patients with localized prostate cancer (PCa). Materials and Methods: We retrospectively analyzed data from 557 patients with localized PCa who were treated with BT (n = 245) or RP (n = 312) at Northern Jiangsu People's Hospital between January 2012 and December 2017. Biochemical relapse-free survival (bRFS) and cancer-specific survival (CSS) were compared by treatment modality. Multivariate Cox regression analysis was used to evaluate bRFS. Health-related quality of life (HRQoL) was measured using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. Results: The BT group was older and had a higher initial PSA (iPSA). The 5-year bRFS was 82.9% in the BT group versus 80.1% in the RP group (p = 0.570). The 5-year CSS was 96.4% in the BT group versus 96.8% in the RP group (p = 0.967). Based on multivariate Cox regression analysis, Gleason score ≥ 8 was the main independent prognostic factor for bRFS. Regarding the HRQoL, compared with the baseline, both treatments produced a significant decrease in different aspects of HRQoL at 3, 6, and 12 months after treatment. Patients in the BT group had lower HRQoL with regard to urinary irritation/obstruction and bowel function or bother, while patients in the RP group had lower HRQoL concerning urinary incontinence and sexual function or bother. There was no significant difference in HRQoL aspects between the two groups after follow-up for 2 years compared with the baseline. Conclusions: BT provides equivalent oncological control outcomes in terms of bRFS and CSS for patients with localized PCa compared with RP. Gleason score ≥ 8 was the main independent prognostic factor for bRFS. BT had better HRQoL compared with RP, except for urinary irritation/obstruction and bowel function or bother, but returned to baseline after 2 years.
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Affiliation(s)
- Fei Wang
- Department of Urology, Municipal Key-Innovative Discipline, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
| | - Yang Luan
- Department of Urology, Northern Jiangsu People’s Hospital, Yangzhou 225001, China
| | - Yaqin Fan
- Departments of Oncology, The First Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
| | - Tianbao Huang
- Department of Urology, Northern Jiangsu People’s Hospital, Yangzhou 225001, China
| | - Liangyong Zhu
- Department of Urology, Northern Jiangsu People’s Hospital, Yangzhou 225001, China
| | - Shengming Lu
- Department of Urology, Northern Jiangsu People’s Hospital, Yangzhou 225001, China
| | - Huazhi Tao
- Department of Urology, Northern Jiangsu People’s Hospital, Yangzhou 225001, China
| | - Tao Sheng
- Department of Urology, Jiaxing Hospital of Traditional Chinse Medicine, Jiaxing University, Jiaxing 314001, China
| | - Deqing Chen
- Forensic and Pathology Laboratory, Provincial Key Laboratory of Medical Electronics and Digital Health, Institute of Forensic Science, Jiaxing University, Jiaxing 314001, China
- Correspondence: (D.C.); (X.D.)
| | - Xuefei Ding
- Department of Urology, Northern Jiangsu People’s Hospital, Yangzhou 225001, China
- Correspondence: (D.C.); (X.D.)
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